“专科-全科”联合教学在培养全科医师慢性病规范管理中的实践与探索

The practice and explorations of the Specialist-General practice joint training of general practitioners in the chronic diseases management

目的为适应分级诊疗制度,规范管理社区常见慢性非传染性疾病(慢性病),提升全科医师专业素质,探索全科医师继续医学教育新模式。方法本文以一家国家级全科医学住院医师规范化培训临床轮转基地联合两家社区实践基地,确立社区前5种需要规范管理的常见慢性病,将中级及以上职称的社区全科医师纳入为期半年的"专科-全科"联合培养教学,形式有理论培训、"专科-全科"联合教学查房、全科医学门诊带教等。以培养前后慢病管理专业知识测评合格率,5种慢性病就诊、转诊人次数及家庭医师签约续签人数来评价培养效果。结果共有31名社区全科医师参加"专科-全科"联合教学模式培养。经培养后,慢性病管理专业知识有所提升,全科医师培养前后合格率差异有统计学意义(P<0.05);5种慢性病转诊率下降,培养前后差异具有统计学意义(P<0.05);家庭医师签约续签率上升,培养前后差异具有统计学意义(P<0.05)。结论"专科-全科"联合教学可提升社区全科医师对常见慢性病规范管理专业能力,提高医学继续教育质量,促进全科医学发展,值得进一步实践和探索。

Objective In order adapt to the hierarchical diagnosis and treatment system,standardize the management of common chronic non-communicable diseases (chronic diseases) in the community and improve the professional qualities of general practitioners,this study aimed to explore new models of continuing medical education for general practitioners.Methods We selected one national standardized training base with two community clinical bases,and firstly established top 5 common chronic diseases in the community that need to be standardized managed.The community general practitioners with intermediate titles or above were included in the halfyear special-general practice joint teaching and training,and the training aspects included theoretical training,special-general joint teaching rounds,and general medical clinic teaching.The training effect was evaluated by the qualified rates of professional knowledge in chronic disease management before and after training,the numbers of patients referrals with these five chronic diseases and the numbers of general practitioners signing renewals.Results A total of 31 community general practitioners participated in the study of special-general practice joint teaching model.After training,their professional knowledge of chronic disease management were improved,and the differences of the qualified rates before and after the training of general practitioners was statistically significant (P < 0.05).The rates of patient referrals with these 5 chronic diseases decreased,and the differences before and after training was statistically significant (P < 0.05);the rate of general practitioners ' contract renewal was significantly increased (P < 0.05). Conclusion The special-general practice joint teaching can improve the professional abilities of community general practitioners in the management of common chronic diseases,improve the qualities of continuing medical education,and promote the development of general practice.It is worth further practice and exploration.